Maine Medicine Weekly Update - 12/23/2020 (Plain Text Version)
In this issue:
Congress Passes New COVID Relief Bill
Congress passed a 5,600-page, $2.3 trillion spending package to fund the government through the end of the fiscal year. It also includes a $900 billion COVID-19 relief bill. Media reports the bill to be among the largest spending bills ever considered by Congress and follows the $2.2 trillion CARES Act passed in late March.
Congress passed a 5,600-page, $2.3 trillion spending package to fund the government through the end of the fiscal year. It also includes a $900 billion COVID-19 relief bill. Media reports the bill to be among the largest spending bills ever considered by Congress and follows the $2.2 trillion CARES Act passed in late March. President Trump is calling on lawmakers to increase the amount of stimulus checks sent to Americans from $600 to $2,000. He did not directly threaten a veto but if he does not sign it by Monday at midnight, the government will shut down.
The COVID-19 relief portion focuses on extending unemployment, providing stimulus checks, and boosting small businesses. It does not include the much-discussed issues of increased state funding assistance or business liability protections. The legislation does maintain several abortion-related restrictions, such as the long-standing Hyde amendment that prevents federal funds from being used for abortions. There are also energy provisions that would restrict the use of hydrofluorocarbons, deemed to be the first significant piece of climate legislation in over a decade. Specific COVID relief relevant to physicians and health care include:
o There will be an increase in the payment schedule of 3.75 percent
o Payments for HCPCS code G2211 are suspended for 3 years (through the end of December 2023)
Additionally, the suspension of the Medicare Sequestration cut of 2 percent is continued. Originally set to end on December 31, 2020, the Medicare sequestration cut is pushed out and is now scheduled to end on March 31, 2021.
Temporary freeze of APM payment incentive thresholds. The legislation also freezes the thresholds to qualify for the incentive payments for participating in Alternative Payment Models (APM) at their current levels for two years.
Employee retention tax credit modifications: Extends and Expands the CARES Act employee retention tax credit (ERTC).
$3 billion and new distribution requirements for the Provider Relief Fund.
$1 billion in direct funds to the Indian Health Service to carry out services.
Surprise medical billing legislation was also included in the bill. For services provided by a nonparticipating provider (e.g., physician) at a participating facility or at a nonparticipating emergency facility:
Providers may not bill beyond allowed cost-sharing amount (this amount is based on the recognized amount).
There must be an initial payment (determined by the plan) directly from the plan to the provider, or a notice of a denial, within 30 days from when the provider transmits the bill to the plan.
If the provider is not satisfied with the payment from the plan, they may begin a 30-day open negotiation period.
If an agreement cannot be reached in the open negotiation period, the plan or provider has 4 days to notify other party and Secretary of HHS that they are initiating the Independent Dispute Resolution (IDR) process